title: Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding.
abstract: OBJECTIVE
  To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).
  
  
  METHODS
  Data relating to changes in body mass index (BMI) and procedural complications after RYGB (1995-2009; n = 609; 116M: 493F; 42.4 ± 0.4 years) or LAGB (2004-2009; n = 686; 131M: 555F; 37.2 ± 0.4 years) were extracted from prospective databases.
  
  
  RESULTS
  Pre-operative BMI was higher in RYGB than LAGB patients (46.8 ± 7.1 kg/m² vs 40.4 ± 4.2 kg/m², P < 001); more patients with BMI < 35 kg/m² underwent LAGB than RYGB (17.1% vs 4.1%, P < 0.0001). BMI decrease was greater after RYGB. There were direct relationships between weight loss and pre-operative BMI (P < 0.001). Although there was no difference in weight loss between genders during the first 3-year post-surgery, male LAGB patients had greater BMI reduction than females (-8.2 ± 4.3 kg/m² vs -3.9 ± 1.9 kg/m², P = 0.02). Peri-operative complications occurred more frequently following RYGB than LAGB (8.0% vs 0.5%, P < 0.001); majority related to wound infection. LAGB had more long-term complications requiring corrective procedures than RYGB (8.9% vs 2.1%, P < 0.001). Conversion to RYGB resulted in greater BMI reduction (-9.5 ± 3.8 kg/m²) compared to removal and replacement of the band (-6.0 ± 3.0 kg/m²). Twelve months post-surgery, fasting glucose, total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.
  
  
  CONCLUSIONS
  RYGB produces substantially greater weight loss than LAGB. Whilst peri-operative complications are greater after RYGB, long-term complication rate is higher following LAGB.
authors.affiliation: Nam Q Nguyen, Tamara L Debreceni, Melissa Neo, Carly M Burgstad, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
authors.forename: Nam Q
authors.initials: NQ
authors.lastname: Nguyen
authors.forename: Philip
authors.initials: P
authors.lastname: Game
authors.forename: Justin
authors.initials: J
authors.lastname: Bessell
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Debreceni
authors.forename: Melissa
authors.initials: M
authors.lastname: Neo
authors.forename: Carly M
authors.initials: CM
authors.lastname: Burgstad
authors.forename: Pennie
authors.initials: P
authors.lastname: Taylor
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008077:Lipoproteins, LDL; D002784:Cholesterol
keywords: Bariatric surgery; Co-morbidity; Complications; Gastric banding; Gastric bypass; Outcomes; Weight loss